Nursing School – What Type Of Degree Is Best For You?

So you’ve decided on a career in nursing, but you don’t quite know where to start. What type of nursing degree is best for you? What type of nursing school should you go to?

There are two basic types of nursing degrees: A degree in Licensed Practical Nursing, (called Licensed Vocational Nursing in some states) and a degree in Registered Nursing.

The LPN degree can be a good starting point for your nursing career. You need a high school diploma or GED to be accepted into an LPN school. Many community colleges and technical schools offer LPN degrees. Not many four-year state universities offer them. Some private, for-profit schools in your area probably offer them as well; Galen, Kaplan, Keiser, and the University of Phoenix are all examples of these types of schools.

LPNs earn less than registered nurses and work under the direction of registered nurses. Some hospitals will not hire LPNs and only hire registered nurses.

If you want to progress into a managerial position as a nurse, you will want to become a registered nurse. One way to do this is by becoming an LPN first and then, while you are working as an LPN, taking an LPN to RN program online or at your local community college. The advantage to this is that you will be working and bringing in a salary, and also, your employer will very likely help pay for your continuing education (usually in return for signing a contract that ensures that you will continue working for them for a specificfied period of time.)

Another way to do this is by getting an Associate’s Degree in Nursing, which takes two years, or a Bachelor of Science Degree in Nursing, which takes four years. These are available at many two-year community colleges and four-year private and state colleges. Many private for-profit career schools are opening up these days which offer two-year Associate’s Degree in Nursing Programs.

Once you get an Associate’s Degree in nursing you are a Registered Nurse. If you want to earn more money and increase your hiring potential, you can working while taking classes part-time to get a Bachelor of Science Degree in nursing. Often your employer will pay for some or all of your educational expense.

If you want to be a manager, you will most likely have to have a Bachelor’s of Science in Nursing, and many facilities will require a master’s degree in nursing.

So which option is better for you? There are a number of considerations, such as how quickly you want to get your degree and start working. An LPN degree will get you working more quickly. However, if you know that you want to progress further in your career, possibly into a management position, and you have the time, money and ability to go to school for two to four years, you may want to consider obtaining a degree in registered nursing instead.

Literature Review For Nursing Stress Interventions

Stress is a well-known and identified problem within the nursing profession. According to Atkinson stress occurs when one is faced with events or encounters that they perceive as an endangerment to their physical or psychological well being (as sited in McGowan, 2001). Additionally stress levels will increase when controllability and predictability in a situation decrease. There is an inverse relationship between stress and job satisfaction, as stress goes up, job satisfaction falls. As a result this increased stress could commonly results in decreased job satisfaction and decreased quality of life. This could potentially contribute to nurses leaving the profession and as an end consequence, account for the current nursing shortage.

The cause of stress for nurses has found to be related to the nature of the profession. Included in these stressors are an intense work environment with extended work hours, weekends, night and holidays. According to Ruggiero (2003) stress could be related to variables of shift work, which is both physically and mentally taxing. This study also found varying degrees of depression in nurses ranging from mild to severe. Finally this study revealed that nurses were indifferent and disconnected to the job by feeling neither satisfied or unsatisfied with the work. Results such as these expose how large a problem stress is for the profession of nursing.

Factors of the intense emotional support that is needed for the patient and family is yet another burden of stress placed on nurse. In addition, exposures to pain, suffering and traumatic life events that the nurse experience on a daily basis can contribute to stress (Cohen-Katz, Capuano, Baker, & Shapiro, 2005). These concerns can lead to emotional exhaustion for nurses.

The lack of organizational support and involvement, which are outside of the control of nurses can greatly affect job satisfaction (McGowan, 2001). There is also a lack of control and power in an environment predominantly controlled by physicians. These stressors can contribute to psychological exhaustion and increased stress.

Consequently this leads to the question of what supportive interventions have been implemented for nurse, to decrease their stress thereby increasing their coping mechanisms. Would the availability of stress reducing programs contribute to coping mechanism and increase job satisfaction? Additionally how effective are these interventions?

In my initial search for stress interventions I encountered many studies located in the Ovid database that site stress in nursing and other related health care field. Key words such as stress management, burnout, job satisfaction, nursing retention, quality of life, environment and alternative therapies were utilized for this search. These studies revealed definitions of stress and countless and various causes and explanations for the stress experienced by nurses and other health care workers.

There were comparative studies between different nursing backgrounds and environment. For medical-surgical  nursing  verses home-health nursing (Salmond & Ropis, 2005), which examined and compared the differences in both backgrounds. Ultimately it found both areas of practice had their own version of stress and it identified common stressors. Unfortunately no concrete measures were utilized to combat the problem

There were also illustrations comparing different styles of management and how nursing stress is affected. Magnet organizations were compared with traditional organization (Upenieks, 2003). The results of this particular study did prove that positive and supportive administration could make a difference in the levels of stress but again no specific stress intervention measures were used

There is a clear recognition and acknowledgement of the problem of stress in nursing but there is a significant lack of information that actually addressed the problem with potential positive interventions. The few studies discovered were all found to show positive results to some degree. These findings support the positive outcome that the initiation of actual stress interventions or programs within the workplace can offer.

The first study used the physical intervention of massage therapy over a 5 week period for nurses in a hospital facility (Bost & Wallis, 2006). This intervention was identified to reduce stress as well as support nurses individually and organizationally. The effects measured were physical and psychological. The study found no change in the physical findings of blood pressure and urinary cortisol levels, however there was decrease in the State-Trait Anxiety Inventory (STAI) in the treatment group compared to the control group. Although there was no physical benefits measured it did reduce the psychological effects of stress. These results suggest that offering the intervention of massage therapy is beneficial in decreasing anxiety levels, which in turn could reduce stress.

The other interventions researched involved a more interactive process. These studies called upon the motivation of the participants or nurses to take part in the intervention. The involvement of these nurse participants supports a need to decrease stress by their desire to assist in making changes internally that will affect them externally.

The use of mantra to relieve stress was one of these interventions. This examined the effectiveness of using a mantra or repeated mantra to affect the level of stress and emotional and spiritual well being. Mantra utilization was taught to health care workers through a 5-part intervention program offered through the hospital prior to the study (Bormann et al., 2006). This is a good example of a valid and tangible intervention that can be offered to increase coping mechanism while decreasing stress. The findings supported the positive results of this study by showing a significant reduction in perceived stress (Perceived Stress Scale), trait anxiety (State-Trait Anxiety Inventory), and trait anger (State-Trait Anger Inventory) post intervention. There was also an increase in quality of life and existential and total spiritual well-being.

Mindfulness-Based Stress Reduction (MBSR) Program was a series of quantitative and qualitative studies offered and taught within the hospital work environment. This program specifically addressed the issue of stress for nurses. MBSR is based on the concept of becoming mindful and fully present in the moment without judgment (Cohen-Katz et al., 2005). The study measured levels of burnout, emotional exhaustion, emotional overextension and psychological distress.

This particular intervention program not only decreased the stress level post treatment but the control group also experienced a benefit prior to treatment while waiting for the program. This could be related to the desire to reduce stress in anticipation of participating in the program. This further support the need nurses have to make changes for the better by decreasing stress levels.

This MBSR study again found a reduction in emotional exhaustion and an increased feeling of personal accomplishment in the treatment group post intervention. Furthermore these effects led to a decrease in stress that had a lasting affect over a three-month period. This validates the positive effects of the use of this intervention in the reduction of stress.

A third positive interactive intervention study was a program, which offered a conflict-management training class in order to decrease potential stress for employees in health care organizations. This particular study also supported the need to offer a way to prevent or decrease stress by creating a positive environment through personal empowerment. There was a significant reduction pretest and posttest in role overload, interpersonal strain, role boundaries and psychological strain. The participants reported that they were better able to find balance in their position and were able to manage the demands of their job (Haraway & Haraway, 2005). These findings confirm the need to make available even brief interventions such as this in an effort to reduce conflict. This could in turn reduce stress and increase perceived control and empowerment, which increases job satisfaction. Furthermore this would improve work environment by making it more supportive

All of these programs discussed, offered intervention for at least one aspect of possible stress factors. Reducing physical or emotional stress and offering more control and empowerment while creating a more positive working environment are all successful interventions to increase job satisfaction. Consequently increased job satisfaction leads to decreased stress. The results of this study suggest a strong link was identified between the two issues (Ruggiero, 2003).

There is a common thread within all these interventions. They are available and effective interventions that can be implemented to become a part of nursing practice and other health care workers in many different health care settings. These actual structured group interventions could be more effective to create a decrease in stress individually. Programs such as these have a proven value and are a simple easy and relatively inexpensive intervention. Offering them to nurses and other health care employees could be considered a preventative measure for potential stress.

In addition these findings substantiate the need for regular stress reduction programs to be offered through hospitals and other medical employment organizations. The use of these and similar programs provide a far reaching benefit for the nursing profession. Anticipatory measures for the reduction of stress can increase job satisfaction, potentially increase nursing retention. Goals for these programs could include guidance in the stress management techniques, increase social support, open communication, role strengthening and empowerment and individual growth to fully utilize positive interventions (Cohen-Katz et al., 2005).

Future studies in programs for stress intervention should include additional similar studies offered to a larger sample with long term and ongoing evaluations of their effectiveness. Consideration of other alternative adjunct intervention therapies that assist in stress reduction could be examined such as yoga and mediation. The use of these physically and emotionally stress-reducing techniques may also be effective in stress lessening and coping measures increasing.

It is my hope that in the future interventions to prevent stress in nurses and health care workers will be offered as a standard part of a benefit package within all health care organizations. Stress prevention can be a win-win situation where everyone will benefit. Nurses will have decreased stress and increased coping mechanism, which will increase job satisfaction. This could lead to increased nurse retention. Subsequently as result of this contentment and increased quality of life the nurse will be a superior employee and better able to provide care for themselves and their patients.

References

Bormann, J. E., Becker, S., Gershwin, M., Kelly, A., Pada, L., & Smith, T. L. et al. (2006). Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers. The Journal of Continuing Education in Nursing, 37(5), 218-224. Retrieved October 3, 2006, from Ovid data base

Bost, N., & Wallis, M. (2006). The effectiveness of a 15 minute weekly massage in reducing physical and psychological stress in nurses. Australian Journal of Advanced Nursing, 23(4), 28-33. Retrieved September 6, 2006, from Ovid data base

Cohen-Katz, J., Capuano, T., Baker, D. M., & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, part II. Holistic Nursing Practice, , 26-35. Retrieved September 27, 2006, from Ovid data base

Haraway, D. L., & Haraway, W. M. (2005). Analysis of the effect of conflict-management and resolution training on employee stress at a healthcare organization. Hospital Topics: Research and Perspectives on Healthcare, , 11-17. Retrieved October 28, 2006, from Ovid data base

McGowan, B. (2001). Self-reported stress and it’s effects on nurses. Nursing Standard, 15(42), 33-38. Retrieved September 28, 2006, from Ovid data base

Ruggiero, J. S. (2003). Health, work variables, and job satisfaction among nurses. JONA, 35(5), 254-263. Retrieved October 3, 2006, from Ovid data base

Salmond, S. & Ropis, P. E. (2005). Job stress and general well-being: a comparative study of medical-surgical and home care nurses. Retrieved September 28, 2006, from Ovid data base

Upenieks, V. V. (2003). The interrelationship of organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction. Health Care Manager, 22(2), 83-98. Retrieved September 27, 2006, from Ovid data base

The Vital Role of Public Health Nursing

A survey done by the Department of Health of United Kingdom reveals that about 74% of adults in United Kingdom consumed an alcoholic drink daily. Worse still, more than 37% individuals reported they didn’t know the harmful effects of addiction to alcohol. These statistics reveal two things and they are as below:

– Adults getting addicted to alcohol and

– Adults are unaware of the health consequences.

These worrying signs could be replicated to almost any country. That is probably why public health nursing plays a key role in curbing this menacing statistic.

A public nurse would work to create awareness in the community about certain health issues. They identify the health care needs of a population and further, find out the needs depending on the sub-populations, families etc. This way, families who could be at a risk of infecting a certain disease receive immediate healthcare aid thereby ensuring good health at all times. The public health nurses normally adopt a systematic approach to finding a fix for the health care needs of a society. They would meet community heads, families and study data related to the general health of the section of the society.

Bio-terrorism and epidemics are a serious threat to any society, and public health nurses with their regular campaigns work to ensure people are constantly updated about these issues and how to tackle them, if and when they arise. Most importantly, they would also study the possible risk factors to health of a society based on the demography of the society. For example, a public health nurse would counsel and advocate health protective measures to a society if it is in the vicinity of a chemical factory. In such an example, the nurse would counsel on what needs to be done in case of a chemical leak and so on.

Public nurses take a scientific approach to help them fix some health issues plaguing the society. Basically, they educate the society about possible health problems and ensure that the society and the community, as a unit responds to any health challenge posed to them. They also help in providing healthcare aid in the event of a community epidemic. By all counts thus, the role of a public health nurse in ensuring good health of individuals, cannot be discounted.

Mao’s Last Nursing Home

The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of communism is the equal sharing of miseries – Churchill

There is a nursing home in Wuxi called Liang Xiao (name changed). It is located down a side alley off a busy street not far from the central train station. Like most acute care facilities in China, it is a grey and depressing place with little apparent security and wholly inadequate patient supervision. I don’t know when Liang Xiao was built and the distressed nature of the buildings offer little clue; most public facilities (with the notable exception of important government offices) are poorly constructed, it could just as easily be 10 years old as it could 30 years old. In all, Liang Xiao seems as hopeless and miserable a place as are its despondent and forlorn patients; fragility seems the least of their ailments as patient quality of life is non-existent. To be fair though, Liang Xiao did have an uncommon amount of activity and the type of motion that suggests design; but it wasn’t clear at the time just what it was all about.

I was invited to visit Liang Xiao as a result of one of their nurses having read contacted me via Weibo, the Chinese Twitter. We arranged our visit and scheduled the trip for an early afternoon arrival. Our hosts were the doctors and nurses who run the facility and we were told, the “Chairman” of the company. This last bit of information was curious as I was under the impression that all nursing homes were owned by the state. The purpose of our invitation was to learn if there was any opportunity for us to consult and assist Liang Xiao with their interest in upgrading their geriatric care program.

Shortly after our arrival and once done with the ceremonial exchange of business cards, fanfare of good wishes, obligatory sip of tea and taste of fruit, we were offered a tour of Liang Xiao which we graciously accepted and were told that Mr. Chang would be slightly delayed. Twenty minutes into our tour the Chairman arrived with an entourage of 6 men attending to his calls, carrying his 3 briefcases and just generally making a scene about his arrival. Clearly, the intended impression to be conveyed by this activity was that Mr. Chang was exceedingly important and a much too busy person with whom to be trifled. Our tour guide noticed Mr. Chang’s entrance and nervously diverted us from our route to the courtyard in the center of Liang Xiao where a brief introduction was to be made and photos taken. Mr. Chang was given our brochure by one of his assistants and as he read it out loud, he shook each of our hands. Once the introduction was complete, Mr Chang insisted that our tour be postponed until later that afternoon and we should all, at once, retire to the luncheon which had been especially prepared for us.

Our lunch cleared up the mystery of the “Chairman” as well as Liang Xiao’s noticeable bustle and opened a door into what might well be the future of nursing homes in China. Calling Mr. Chang a businessman is a profound understatement, as he is more aptly described as one of China’s new generation of ravenous entrepreneurs, a new breed of savvy and sharp-eyed capitalists who can spot opportunity a mile away. Mr. Chang’s story begins a couple of years ago when the 12th 5 year plan was being written and the government began to allocate funds for the development of senior living facilities. Through what I can only imagine is a carefully constructed and meticulously maintained, salubrious network of political and business contacts (the guangxi must be legendary!) in Wuxi, Mr. Chang crafted himself an opportunity from the ruins of Liang Xiao. And while Mr. Chang doesn’t know a thing about nursing care or even the management of such a facility, we must always remember the 4th philosophy of the Joy Longevity Club….General Tsao’s copycat chicken with tasty sauce.

Through grants available via the Ministry of Civil Affairs and more importantly private investment, Mr. Chang is slowly turning Liang Xiao around, and even though it may not look like that today, having been to many other nursing homes in China over the past two years, Mr. Chang is clearly on the power curve of his industry. What is even more curious is that Mr. Chang has also “purchased” shares in Liang Xiao and through his private company “owns” a substantial minority stake. I use the quotations for effect here as I have no idea the inner machinations of how he managed this or the details of the structure; like many things in China the means justify the end and it is likely all informally arranged between him and his local government friends. These particulars notwithstanding, it is the big picture that is the point here: Mr. Chang is moving an industry that has long been mired in the stone age of China’s dismal legacy of anemic public healthcare. Mr. Chang and those who come after him in Wuxi (not to mention the 39,545 other public nursing homes in China) will no doubt profit handsomely from their efforts and they should; theirs is truly a herculean task.

This all reminds me in a way of Li Cunxin’s gripping autobiography Mao’s Last Dancer (and subsequent film adaptation by Bruce Beresford in 2009). In his book, Li Cunxin is born into a poor family commune in a small rural village in Shandong Province, where he is destined to work in the fields as a laborer. At first overlooked but eventually selected after suggestion by his teacher during a school visit, Li seems bewildered by the gruff preliminary inspection screening at the province capitol city of Qingdao. He is selected to travel to Beijing to audition for a place in Madame Mao’s Dance Academy, and is admitted to its ballet school after passing a series of physical examinations. Years of arduous training follow, until his initial mediocre performance is finally overcome due to inspiration from a teacher’s devotion to classical ballet as opposed to the politically motivated, strident form favored by Madame Mao. His determination and courage leads to him being grudgingly permitted by the Academy to travel abroad to Ben Stevenson’s Houston Ballet company as a visiting student for three months. In the United States, he begins to question the Chinese Communist Party dictates upon which he has been raised, detaches himself from his political past, defects and flourishes as a dancer.

I see Mr. Chang as China’s healthcare Li Cunxin; a charismatic, determined soul who sees more and desires a better circumstance for himself and his business and is frustrated with the status quo. The big difference between Li Cunxin and Mr. Chang is that Mr. Chang no longer has to defect to realize his ambition; China has learned to provide opportunities for those who are motivated enough.

A short injection of China’s nursing home history

In 2000, China’s Ministry of Civil Affairs announced the “Star Light (Xing Guang) Program” whereby the Ministry allocated 20% of the social welfare lottery fund to build community welfare facilities for seniors. From 2001 to 2004, the Chinese government invested a total of 13.4 billion yuan in this program and built 32,000 “Star Light Centers for Seniors.” I want to thank Leung-Wing Chu, FRCP, and Iris Chi for this information as they did a great deal of research in this respect. The services of these centers are overly broad with multiple functions and cover family visits, emergency aid, day care, health care services, and recreational activities to over 30 million elders. At the same time, the government also increased its investment in building nursing homes to provide institutional care for older people in the “Star Light Program”. Another program, the “Beloved Care Engineering” program began in 2005 and is aimed at increasing the number of nursing homes and encouraging good nursing home care quality through a government-sponsored Elder Care Foundation. These facilities range from senior citizens’ lodging houses (apartments), older people homes, and nursing homes for the aged, which serve to meet elders with different functional abilities and financial backgrounds. The building of older people homes in rural areas was also encouraged for persons who can avail themselves of the “5 guarantees” which, when translated, are the basic needs of “food,” “clothing,” “accommodation,” “health care,” and “burial service”. Those who can usually find their way into such accommodations are usually former revolutionary guards, government employees or other “proud” occupation. By the end of 2005, there were 39,546 institutions providing vastly different types of services for seniors with most providing subpar care, when compared with their Western counterparts (an admittedly unfair comparison). In total these institutions provided 1.497 million beds.

If providing nursing homes was the only issue then China would be well on her way, however that is the least of concerns. As with most endeavors on the mainland, human resources or lack thereof is usually the issue that trumps the best laid plans. The major source of healthcare workers are (often called “bao mu” in Chinese) laid-off workers in previously state-run factories, migrant workers from rural villages or unemployed ethnic minorities. They often do not have any training in elder care or nursing home care before they start working in the nursing homes for older adults. For laid-off workers, 1 to 2 days of short training in basic personal care is provided free of charge by some local government agencies, for example the Labor, Social Security Bureau, China Committee on Aging, and Women’s Federation. However, none of these workers are required to have formal training in geriatric care before they enter into their work. As a result, the quality of care is grim and dangerously low. These workers are often required to pay a fee for these training courses and as this imposes a great financial difficulty, they usually do not enroll before they commence working. Such labor also presents other issues for working in nursing homes; different language or dialect, customs from those of urban cities’ older people and cultural prejudices of patients who often dislike their care being given by “bao mu”.

We haven’t yet begun our work with Mr. Chang, although I am confident we will do a great deal with him. And as you can imagine, the benefits of working with such a person extend far beyond simple contract remuneration. His highly choreographed performance to date in raising Liang Xiao from little more than a living graveyard to real, albeit spartan, nursing home is nothing short of virtuosic.